EP0113200B1 - Appareil médical de mesure non invasive de caractéristiques cardio-vasculaires - Google Patents

Appareil médical de mesure non invasive de caractéristiques cardio-vasculaires Download PDF

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EP0113200B1
EP0113200B1 EP83307347A EP83307347A EP0113200B1 EP 0113200 B1 EP0113200 B1 EP 0113200B1 EP 83307347 A EP83307347 A EP 83307347A EP 83307347 A EP83307347 A EP 83307347A EP 0113200 B1 EP0113200 B1 EP 0113200B1
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heart
subject
beat
digital data
sinus arrhythmia
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EP0113200A1 (fr
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William J.M. Hrushesky
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Hrushesky William JM
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/48—Other medical applications
    • A61B5/486—Bio-feedback
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/024—Detecting, measuring or recording pulse rate or heart rate
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S128/00—Surgery
    • Y10S128/905—Feedback to patient of biological signal other than brain electric signal

Definitions

  • the present invention relates to an apparatus for measurement of a cardiovascular function.
  • the present invention relates to a totally noninvasive, quick and simple medical instrument for measurement of cardiovascular characteristics during voluntary cardiorespiratory synchronization.
  • EKG electrocardiogram
  • the interpretation of an electrocardiogram requires a skilled physician, who must make a number of qualitative as well as quantitive decisions to determine whether or not the subject's cardiovascular system is within a normal range.
  • the electrical signals comprising the EKG record convey information which is strictly limited to the electrical activity of the cardiovascular tissue.
  • Bainbridge proposed that the greater the negative intrathoracic pressure generated by each inspiration, the greater the cardiac filling and quicker the subsequent pulse.
  • Bainbridge, F. A. "The Relationship Between Respiration and the Pulse Rate", J. Physiol. 54:192-202, 1920.
  • VCRS Voluntary Cardiorespiratory Synchronization
  • the light driver circuits converted the desired pattern to a visual signal which advised the subject to inhale or exhale, each for the preselected number of beats.
  • the system was "closed” when the subject voluntarily breathed according to these visual instructions. Thus respiration and heart beats were synchronized. If the subject could follow these simple visual instructions and the heart was in sinus rhythm, any reasonably comfortable pulse: inhale; pulse: exhale ratio could be achieved.
  • the invention provides in one aspect apparatus for noninvasive quantitative measurement of characteristics of a cardiovascular system of a human subject, including: noninvasive pulse transducer means for providing signal pulses representative of sensed heart beats of the human subject; and voluntary cardio-respiratory synchronisation means responsive to the signal pulses for providing stimulae which permit the human subject to voluntarily synchronise the subject's respiratory cycles with the subject's heart beats so that each respiratory cycle has a period corresponding to a predetermined number N of heart beats; and characterised by: instantaneous heart rate measurement means responsive to the signal pulses for providing digital data - representative of instantaneous heart rate at each heart beat of a plurality of N-beat voluntary synchronised respiratory cycles; data sorting means for sorting the digital data by the corresponding heart beats within the N-beat voluntary synchronised respiratory cycles; means for deriving a cosine curve which best fits the sorted digital data; means for determining rhythm parameter values including a sinus arrhythmia amplitude value which is a function of the peak to
  • the apparatus may further comprise means for computing mean and a standard error digital values based upon the sorted digital data; means for computing an index representative of a characteristic of the subject's cardiovascular system based upon the mean digital values; wherein the output means provides an output as a function of the index.
  • the invention provides apparatus for noninvasive quantitative measurement of heart tissue compliance of a cardiovascular system of a human subject, comprising; noninvasive pulse transducer means for providing signal pulses representative of sensed heart beats of the human subject during a plurality of respiratory cycles in which multiple heart beats occur; and voluntary cardio-respiratory synchronisation means responsive to the signal pulses for providing stimulae which permit the human subject to voluntarily synchronise the subject's respiratory cycles with the subject's heart beats so that each respiratory cycle has a period corresponding to a predetermined number N of heart beats; and characterized by: instantaneous heart rate measurement means for providing digital data representative of instantaneous heart rate at each sensed heart beat based upon the signal pulses; means for storing the digital data for each sensed heart beat; data sorting means for sorting the stored digital data by the corresponding heart beat within the N-beat voluntary synchronised respiratory cycle in which it occurred; statistical analysis means for deriving a plurality of digital statistical values based upon the sorted digital data; rhythmometric
  • the present invention is an apparatus for measuring the condition of the cardiovascular system of a human subject.
  • the present invention provides a precise and highly reproducible quantitative measurement of sinus arrhythmia.
  • pulse transducer means provides signal pulses representative of sensed heart beats of the human subject.
  • Voluntary cardiorespiratory synchronization means provides stimulae to the human subject as a function of the signal pulses. The stimulae permit the human subject to voluntarily synchronize the subject's respiratory cycles with the heart beats, so that each respiratory cycle corresponds to a predetermined number N of heart beats. This voluntary synchronization is continued for a plurality of respiration cycles.
  • Instantaneous heart rate measurement means provides digital data which represents the instantaneous heart rate of each beat of the N-beat voluntarily synchronized respiratory cycles. This digital data is based upon the time interval between signal pulses.
  • the digital data are sorted by beat by data sorting means.
  • Data analysis means analyzes the sorted digital data to derive one or more digital values indicative of a characteristic of the subject's cardiovascular system.
  • Output means provides a human perceivable output as a function of the derived digital value.
  • the data analysis means performs rhythmometric, statistical, and/ or arithmetic analyses based upon the sorted digital data.
  • rhythms can be separated into three domains: circadian (having a period of about twenty-four hours); infradian (having a period greater than twenty-eight hours); and ultradian (having a period less than twenty hours).
  • the sinus arrhythmia is an example of a high frequency ultradian rhythm.
  • the period of the sinus arrhythmia during voluntary synchronization corresponds to N heart beats (i.e. one respiration cycle).
  • the data analysis means first determines an average instantaneous heart rate for each heart beat of the respiratory cycle.
  • the data analysis means fits the average instantaneous heart rates to a cosine curve by least squares fitting procedures using single cosinor rhythmometric analysis.
  • the data analysis means determines rhythm parameter values, including a sinus arrhythmia amplitude value, a rhythm qualified mean heart rate (mesor), a timing value (acrophase) which indicates the location of the peak of the cosine curve in the respiratory cycle, and a percent rhythm value which indicates the quality of the fit of the cosine curve and the stored instantaneous heart rates.
  • An output is provided which can be compared to outputs from a wide variety of age, disease, and sex matched subjects as well as with outputs from previous determinations on the same subject.
  • This output indicates the condition of the cardiovascular system of the human subject based upon the values derived from the rhythmometric analysis, particularly the sinus arrhythmia amplitude.
  • Equally valuable information may also be obtained when the data analysis means performs statistical analyses which include determination of the means and standard errors of instantaneous heart rate for each beat (1-N), an analysis of variance of these means, as well as creation and inspection of various sample arithmetic indices relating to these instantaneous heart rate means.
  • One of these indices includes the computation of a modulation index.
  • the data analysis means determine this modulation index by dividing the difference between the means of the highest and lowest instantaneous heart beat rates by the overall mean rate.
  • the modulating index would equal 80-60 or 20 divided by the average rate of 70 (20/70) or 0.29.
  • Many other indices may also be created to relate directly measured values of instantaneous heart rate.
  • the present invention permits a precise and highly reproducible measurement of sinus arrhythmia amplitude. Utilizing the present invention, it has been determined that the measured sinus arrhythmia amplitude appears to provide indication of the compliance of the subject's heart tissue. The present invention provides a quantitative indication, therefore, of heart tissue compliance and thus the functional of physiological (as opposed to chronological) age of the subject's cardiovascular system.
  • the present invention makes it possible to monitor the effects of cardiotoxins cardioactive drugs and other substances on the cardiovascular system in a previously unavailable quantitative manner.
  • instantaneous heart beat information obtained during voluntary cardiorespiratory synchronization is analyzed utilizing cosinor rhythmometric analysis and other analytic methods to provide an instantaneous, precise and highly reproducible assessment of sinus arrhythmia amplitude. It has been discovered that the sinus arrhythmia amplitude as measured utilizing the present invention decreases with advancing age, and thus provides a measure of cardiovascular physiological age. In addition, it has been found that the measured sinus arrhythmia amplitude is a sensitive indicator of the effects of substances such as cardiotoxins on the heart tissue.
  • the present invention therefore, provides a quick, easy, reliable and totally noninvasive method of measuring cardiovascular conditions, with no risk of physical harm to the human subject.
  • the ability to provide a quantitative measurement of sinus arrhythmia amplitude (as well as other parameters of cardiovascular performance), and the apparent direct relationship between that amplitude and heart tissue compliance provides a very wide range of applications for the present invention in medical practice, public health and health care maintenance.
  • Figure 1 shows a block diagram of sinus arrhythmia testing instrument 10 of the present invention.
  • Instrument 10 includes pulse transducer 12, voluntary cardiorespiratory synchronization (VCRS) circuit 14, inspire indicator light 16, expire indicator light 18, inspire/expire ratio selector 20, keyboard 22, display 24, printer 26, microcomputer 28, timer 30, and data storage 32.
  • Instrument 10 provides a quantitative analysis of sinus arrhythmia of a human subject while the subject is voluntarily synchronizing cardiac and respiratory cycles.
  • VCRS voluntary cardiorespiratory synchronization
  • Pulse transducer 12 senses heart beats of the human subject.
  • pulse transducer 12 is a simple, noninvasive type of pulse transducer, such as is used in coin-operated machines which measure pulse rates. With this type of pulse transducer, the human subject simply inserts a finger into a cavity in the pulse transducer.
  • Other forms of pulse transducers, such as the electrodes and sensing circuitry of an electrocardiagraph, can also be used, although this is less desirable since it involves attachment of electrodes to the subject's body.
  • pulse transducer 12 is a signal which exhibits an electrical pulse corresponding to the occurrence of each heart beat.
  • the output of pulse transducer 12 is provided to VCRS circuit 14, microcomputer 28 and timer 30.
  • VCRS circuit 14 operates in the manner described in the previously mentioned article by J. Almasi and O. Schmitt.
  • the successive electrical pulses from pulse transducer 12 are counted by VCRS circuit 14, and drive signals are supplied to inspire indicator light 16 or expire indicator light 18.
  • Inspire/expire ratio selector 20 (which in one embodiment is one or more user controlled switches), selects the ratio of heart beats for the inspiration and expiration portions of each respiratory cycle.
  • a ratio of two heart beats for inspiration to three heart beats for expiration appears to be relatively comfortable for the majority of human subjects.
  • the human subject is instructed to breathe in when the inspire indicator light 16 is turned on, and to breathe out when the expire indicator light 18 is turned on.
  • This visually cued voluntary cardiorespiratory synchronization is achieved quite easily and comfortably by most human subjects within a very short time period (seconds).
  • Microcomputer 28 receives the output of pulse transducer 12 and preferably uses the signal pulses to maintain a count of the current beat in the cycle.
  • the output from pulse transducer 12 is also provided to timer 30, which measures the time interval between successive signal pulses.
  • Timer 30 preferably includes one or more counters which count in response to a high frequency clock signal.
  • the signal pulse from pulse transducer 12 causes timer 30 to provide an interrupt signal to microcomputer 28.
  • microcomputer 28 reads the value in timer 30 and resets timer 30.
  • the digital value from timer 30 represents the measured time interval.
  • microcomputer 28 includes a microprocessor, read/write (RAM) data storage, read only memory (ROM) program storage, and interface circuitry required to interface microcomputer 28 with ratio selector 20, keyboard 22, display 24, printer 26, timer 30 and data storage 32.
  • RAM read/write
  • ROM read only memory
  • Microcomputer 28 receives the time interval data from timer 30 during a plurality of voluntarily synchronized respiratory cycles. Based upon this data, microcomputer 28 performs rhythmometric, nonrhythmometric statistical and arithmetic analyses to produce digital values which provide an indication of the condition of the human subject's cardiovascular system.
  • microcomputer 28 determines the instantaneous heart rate. This is based upon the measured time interval between the previous heart beat and the just-received heart beat. Since this time interval represents the time required for one beat, microcomputer 28 calculates the instantaneous heart rate expressed, for example, as the number of beats per minute and stores that data in read/write storage.
  • the test continues for a selected period (such as one minute) during which a plurality of respiratory cycles occur. For example, if the average heart rate of the human subject over the one-minute time period is about seventy-five beats per minute, fifteen continuous synchronized respiratory cycles occur during that minute.
  • Microcomputer 28 accumulates the instantaneous heart rate data for the selected time period, which may be a predetermined length of time, or a predetermined number of respiratory cycles.
  • microcomputer 28 provides an indication to the human subject that the test is completed, e.g., through display 24.
  • an audible signal indicating the completion of the test can be provided by microcomputer 28 by means of a sound transducer (not shown).
  • microcomputer 28 sorts the stored data into the respective first, second, third, fourth and fifth beats of the respiratory cycle.
  • Microcomputer 28 knows the number N of beats in each cycle from the setting of inspire/expire selector 20.
  • Microcomputer 28 then performs data analysis of the sorted data to produce digital values which provide an indication of cardiovascular performance during the synchronized respiratory cycles.
  • microcomputer 28 first performs a statistical analysis based upon the sorted data.
  • Microcomputer 28 computes the mean and standard errors ("MEAN ⁇ SE") for the five beat categories using the sorted data for those beat categories.
  • Microcomputer 28 then performs an analysis of the variance (ANOVA) of the mean across the five beat categories.
  • the result of this analysis by microcomputer 28 is an "f" value which indicates the amount of the variance of the mean and a "p” value which is a probability that the measured data is chance data.
  • MEAN ⁇ SE mean and standard errors
  • ANOVA analysis of the variance
  • f which indicates the amount of the variance of the mean
  • p p
  • Both the mean and the standard error analysis and the analysis of variance of the mean are well known statistical analysis techniques. See, for example, Sokal, R. and Rohlf F., Biometry, The Principles and Practice of Statistics in Biological Research, Chapters 4 and 8 (1969).
  • microcomputer 28 performs a single cosinor rhythmometric analysis. This analysis involves a least squares fit of a twenty-four hour cosine curve to the sorted instantaneous heart rate data.
  • the results of the cosinor analysis are rhythm parameter values: a 5-beat mean heart rate value (mesor); a sinus arrhythmia amplitude which is half of the peak to trough difference of the fitted cosine curve; a timing value (acrophase) of the peak of the cosine curve in degrees or beats from the beginning of the five beat respiratory cycle; a percentage fit value; and 95% confidence level values.
  • microcomputer 28 One preferred program used by microcomputer 28 to perform a cosinor analysis is described in Cornelissen, G., et al, "Chronobiometry with Pocket Calculators and Computer Systems", La Ricerca Clin. Lab., 10, 333 (1980). See also Halberg, F., "Auto-rhythmometry Procedures for Physiologic Self-measurements and Their Analysis", Phsiol. Teach. 1:1-11 (1972) for further description of cosinor analysis.
  • microcomputer 28 performs an arithmetic analysis using either the mean values obtained during the statistical analysis or the rhythm parameters obtained during the rhythmometric analysis to derive one or more indices of cardiovascular performance.
  • a modulation index which is derived by microcomputer 28 by subtracting the lowest from the highest mean instantaneous heart rate and dividing by an overall average rate.
  • an index which is derived by microcomputer 28 by dividing the sinus arrhythmia amplitude value by the mesor value.
  • microcomputer 28 statistically compares derived statistical, rhythm parameter or index values of the sorted data with previously stored values or data in data storage 32. These previously stored values or data are based upon earlier measurements of the same subject, and/or measurements from defined subsets of subjects of precise age categories, physical condition categories, disease categories, cardiotoxin exposure categories, or other drug exposure categories. This analysis, therefore, provides a comparison of the subject's most recent measurements with either his or her previous measurement or with those of similar subjects to provide an indication of how the subject has progressed over time or how the subject compares to others.
  • One preferred statistical analysis performed by microcomputer 28 in this embodiment is the "Hotelling T 2 test". Hotelling, H., Annals of Mathematical Statistics, Volume 2, page 360 (1931).
  • data storage 32 can take any one of several well-known forms. These include floppy disk storage, hard disk storage, or a separate main computer to which microcomputer 28 is linked. The storage data used by microcomputer 28 is selected based upon inputs from keyboard - 22, which identify the subject and/or the subject's characteristics such as age, etc.
  • microcomputer 28 provides a digital value which represents the physiological (as opposed to chronological) age of the subject's cardiovascular system. As described in more detail later, the sinus arrhythmia amplitude value appears to provide a measure of heart tissue compliance which correlates well with physiological age. Microcomputer 28 derives a physiological age value from the amplitude value (or a derived index or combination of parameter values) and the chronological age of the subject entered through keyboard 22. A nomogram stored in the form of a lookup table allows microcomputer 28 to derive physiological age value, which is then displayed or printed.
  • Microcomputer 28 provides-output information through display 24 and printer 26.
  • the particular information to be displayed or printed is based upon instructions which are entered through keyboard 22.
  • the information displayed or printed includes a depiction of the individual instantaneous heart rates measured for each of the five beats; the means and standard errors for each of the five beats; reconstructed cosine curves based upon the rhythm parameter values (which preferably include 95% confidence level depictions); numerical values of the mesor, the sinus arrhythmia amplitude, and the acrophase; a graphic or numerical comparison of the subject with the subject's earlier measurements or with measurements of others; and a numerical display of the physiological age of the heart tissue of the subject.
  • the present invention therefore, can provide detailed data relating to the cardiovascular condition of the human subject in an extremely easy, safe, noninvasive, yet reliable manner.
  • the entire testing to gather the data and the subsequent analysis by microcomputer 28 requires only a matter of a few minutes, including the training time for the human subject to synchronize his/her cardiorespiratory cycles.
  • microcomputer 28 The analyses performed by microcomputer 28 (MEAN ⁇ SE; ANOVA; COSINOR; ARITHMETIC; etc) do not require excessive memory capacity. Nor do the functions of determining instantaneous heart rate, sorting the data into heart beat groups, and the displaying and printing require excessive memory capacity. As a result, the entire system 10 is capable of incorporation in a compact, desk top test instrument. The relatively small size, speed and ease of use of the system 10 of the present invention make its use attractive in a wide variety of medical public health and health care maintenance applications.
  • the sinus arrhythmia amplitude which is derived from the cosinor analysis, is an easily measured index of cardiac function which correlates well in an inverse relationship with cardiovascular physiological age.
  • These tests have shown that the sinus arrhythmia amplitude has little test-to-test variability with the same individual human subjects.
  • the amplitude and timing of the peak of the 5-beat rhythm have been found to change predictably with age.
  • the sinus arrhythmia amplitude has been found to decrease approximately 10 percent per decade between ages twenty and eighty-two, from about 10.8 percent to about 4.4 percent of the mean heart rate.
  • heart beats of the subjects were sensed during voluntary cardiorespiratory synchronization.
  • the instantaneous heart rates were calculated, sorted, and subjected to single cosinor analysis to derive a mesor, amplitude, and acrophase for that subject.
  • Population mean cosinor analysis was then used to combine these parameters from the data series for subsets of the subjects studied. This form of analysis investigates whether rhythm characteristics are consistent among individuals in the group. If individual means, amplitudes, and timings of peak values differ substantially, a statistically significant population mean rhythm will not be indicated.
  • the twenty-five healthy subjects were arbitrarily placed into one of four age categories, each spanning approximately fifteen years (20-35; 35-50; 50-65; and 65-82). Every individual and each age defined population were found to have highly statistically significant five beat rhythms. These age defined populations demonstrated an age dependent decrease in sinus arrhythmia amplitude and a shift in peak timing, whether the data were expressed in absolute terms (beats per minute) or in a relative manner (amplitude as a percentage of mean).
  • the absolute sinus arrhythmia fell from nearly four beats per cycle in the youngest group of subjects to just over 1.3 beats per cycle in the oldest age group.
  • Figure 2 is a graph of composite cosine curves for the four age groups, which show the age dependent changes in sinus arrhythmia.
  • Figure 4 shows the results of linear regression analysis of the decrease of acrophase with advancing age.
  • the mechanisms of the sinus arrhythmia were studied by comparing the sinus arrhythmia of two unusual experimental subjects with that of age-matched control subjects.
  • the first experimental subject was a forty-four year-old man who had received a cardiac transplant several days prior to study.
  • the heart was taken from a thirty-five year-old male accident victim. All sympathetic and parasympathetic nervous connection was, of course, interrupted during extirpation of the heart.
  • the second experimental subject was a forty-seven year-old female with a twenty year history of poorly controlled diabetes.
  • Each of these subjects were studied in order to further illucidate the importance of an intact nervous system to the sinus arrhythmia.
  • the first subject who was studied after a recent heart transplantation, serves as an example in which all central nervous system cardiac communication has been surgically severed.
  • the second subject with diabetic peripheral sympathetic and visceral neuropathy serves as an example in which all small nerves have presumably been damaged by a longstanding metabolic abnormality, as well as perhaps by chemotheraphy for her ovarian cancer. If sympathetic-parasympathetic cardiac innervation is necessary for the manifestation of the sinus arrhythmia each of these subjects should have severely abnormal sinus arrhythmia patterns.
  • the first experimental subject (with the transplanted heart) was studied shortly after removal of all chest tubes. Within a week of this major surgery, he felt well and cardiorespiratory examination was normal. The subject followed instructions well, but the depth of inspiration was somewhat limited by pain from recent median ster- notomy. A statistically significant "sinus arrhythmia rhythm" was present in this subject without cardiac innervation. The sinus arrhythmia amplitude of this rhythm was 1.7 beats per minute and the peak occurred between the first and second beats of the 5-beat cycle.
  • Figure 6 is a graph comparing the sinus arrhythmia in the first experimental subject to the mean sinus arrhythmia rhythm of a group of five age-matched control subjects. The timing of the sinus arrhythmia rhythm of the first experimental subject is precisely the same as the control populations while the amplitude is somewhat lower, perhaps the result of decreased inspiratory effort due to post-operative pain.
  • the second experimental subject had also been treated with seven courses of chemotherapy (Doxorubicin or "ADR").
  • Doxorubicin or "ADR" histone deacetylase
  • the second experimental subject had no clinical or laboratory evidence of Doxorubicin-induced cardiac damage.
  • Urinalysis revealed glucosuria and 2+ albuminuria, a creatinine clearance of 60 cc/minute and fasting blood glucose was usually between 250-500 mg%.
  • the measured sinus arrhythmia for the second experimental subject showed a statistically significant 5-beat rhythm.
  • the amplitude of the rhythm was 1.9 beats per minute compared to the 1.3 beats per minute amplitude of a control subject matched for age, sex, clinical cardiac status, and total Doxorubicin dosage.
  • the timing of the peak for the control subject was between the first and second while that of the diabetic subject was between the second and third beats of the 5-beat cycle. Since the heart rate of the diabetic subject was much higher than that of the control subject, the amplitude relative to the mean heart rate was somewhat, but not significantly, larger than that of the control subject.
  • Doxorubicin a potent cardiotoxin used in cancer chemotherapy, causes a serious and often fatal cardiomyopathy. It damages the heart in a total dose-dependent fashion.
  • the sinus arrhythmia was measured immediately before and one hour after 60 mg/m 2 of body surface area of Doxorubicin was given to patients with advanced cancer.
  • Figure 7 compares these results to the sinus arrhythmia of the thirty-eight age-matched data series from healthy subjects.
  • the sinus arrhythmia of patients who were about to receive Doxorubicin was highly rhythmic and did not differ from the sinus arrhythmia of the control population. In these same individuals, Doxorubicin caused the sinus arrhythmia rhythm to disappear. The sinus arrhythmia amplitude fell by nearly ten fold to undetectable levels. Longitudinal follow-up was possible in two of the patients, one at twenty-four hours and the second one month after Doxorubicin. The disappearance of sinus arrhythmia amplitude persisted for twenty-four hours, but the sinus arrhythmia amplitude returned to near pretreatment levels by one month following Doxorubicin.
  • the chronic administration of Doxorubicin is known to cause total dose-dependent cardiac dysfunction. This was studied using the present invention by comparing the 5-beat sinus arrhythmia rhythm characteristics of thirty-eight data series from age matched healthy subjects with those of six patients who had received two to six courses of monthly Doxorubicin and with those of six patients who had received greater than six courses of Doxorubicin. No patient had received Doxorubicin for a minimum of thirty days prior to sinus arrhythmia testing and no patient had symptoms of heart disease.
  • 550 M g/ M 2 of Doxorubicin caused destruction of the group sinus arrhythmia rhythm in both groups indicating the possible sensitivity of this index to both clinical and subclinical cardiac injury.
  • the present invention utilizes voluntary cardiorespiratory synchronization, the determination of instantaneous heart rate for each heart beat over a plurality of synchronized respiratory cycles, and the statistical and rhythmometric analysis of the instantaneous heart rates sorted by beat. With the present invention, quantification of parameters of the resultant synchronized sinus arrthythmia is achieved.
  • sinus arrhythmia becomes an easily measured index of cardiac function whose amplitude correlates inversely with advancing age. This index has little test-to-test variability within the same individuals. The amplitude and timing of the peak of the 5-beat sinus arrhythmia rhythm both change predictably with age. In addition, tests have shown that the sinus arrhythmia rhythm measured with the present invention is sensitive to the acute and chronic administration of a cardiac poison which causes cumulative heart toxicity.
  • ventricular compliance is the primary variable being measured by the present invention.
  • the more supple the ventricle the more brisk its filling and subsequent emptying in response to negative pressure induced venous filling increase.
  • a program of increasing graded aerobic exercise or the administration of a cardiotonic agent may increase ventricular suppleness and thus increase the sinus arrhythmia amplitude.
  • a nomogram has been constructed on which sinus arrhythmia amplitude and chronologic age are aligned.
  • the nomogram is, in a preferred embodiment, stored in the form of a lookup table or formula by microcomputer 28.
  • the subject's chronologic age is entered through keyboard 22.
  • microcomputer 28 retrieves from the lookup table the estimated physiologic cardiac age, and displays that information on display 24.
  • a thirty-year old person with a stiff ventricle and subsequently a low sinus arrhythmia amplitude of 1.0 will have a cardiophysiologic age of 55 ⁇ 60 years.
  • the subject can longitudinally monitor the effects of therapeutic maneuvers which decrease ischemia, correct hypothyroidism, decrease iron overload, remove quinidine, or reverse Doxorubicin damage.
  • a favorable result will be either an increase in sinus arrhythmia amplitude as measured using the present invention, or at least a decrease in the rate of decline of the sinus arrhythmia amplitude over time.
  • the present invention which provides a fast and simple, yet sensitive quantitative measure of sinus arrhythmia parameters has wide applicability.
  • the present invention is useful in the quantification of physiologic cardiovascular age. Applications include the objective study of aging; sports medicine; physical training; exercise physiology; cardiac rehabilitation; preventive medicine; and general health maintenance.
  • a subject of his physician can monitor the condition of the subject's heart and the effects of training or other measures intended to improve cardiovascular condition.
  • the present invention is useful in the field of toxicology, particularly in the study of the effect of cardiotoxins. This includes the study of the effects of poisonous anticancer drugs; the screening of classes of substances to determine their potential cardiotoxicity; and the quantitation of cardiotoxin effects.
  • the present invention is useful in the field of clinical pharmacology as it relates to cardiac drugs.
  • it is possible to measure the biological effect of particular drugs on the cardiovascular system.
  • the present invention is a quick totally noninvasive and easy test which provides results within a short time period, a succession of tests can be performed to study the effect of a drug over a period of time.
  • the present invention is applicable to the field of endocrinology.
  • the effect of hormone levels on sinus arrhythmia, and in particular cardiovascular compliance can be monitored using the present invention.
  • the present invention has broad applications in the field of basic cardiovascular physiology. Although the effects of sinus arrhythmia have been noted for over 250 years, the precise mechanisms involved are still not fully understood. As described previously, the study of sinus arrhythmia using the apparatus of the present invention with both normal subjects and subjects having unusual conditions (for example the heart transplant subject) provides information which leads to a more complete understanding of the cardiovascular system.

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Claims (3)

1. Dispositif pour l'exploration fonctionnelle quantitative non invasive de caractéristiques du système cardiovasculaire d'un sujet humain, comprenant:
- des moyens non invasifs (12) de transducteur d'impulsions fournissant des signaux représentatifs des battements cardiaques détectés sur le sujet humain; et des moyens de synchronisation cardio-respiratoire volontaire sensibles aux impulsions de signaux fournissant des stimuli qui permettent au sujet humain de synchroniser volontairement ses propres cycles respiratoires avec ses battements cardiaques de telle façon que chaque cycle respiratoire ait une période correspondant à un nombre N prédéterminé de battements cardiaques; et caractérisé par:
- des moyens (28) de mesure de la fréquence instantanée des battements cardiaques sensibles aux impulsions fournissant des données numériques représentatives de la fréquence instantanée des battements cardiaques à chaque battement cardiaque d'une pluralité de cycles respiratoires synchronisés volontaires avec N battements; des moyens (28) de tri des données pour trier les données numériques selon le battement de coeur correspondant dans les cycles respiratoires synchronisés avec N battements; des moyens (28) pour déduire une cosinoïde qui s'accorde au mieux avec les données numériques triées,
- des moyens (28) pour déterminer des valeurs de paramètre de coïncidence comprenant une valeur d'amplitude de l'arythmic sinusale qui est une fonction de la différence maximum/mini- mum de la cosinoïde; et des moyens (28, 22, 24) de sortie fournissant un signal de sortie fonction de la valeur de l'amplitude de l'arythmie sinusale, lequel signal de sortie est représentatif d'une caractéristique du système cardio-vasculaire du sujet.
2. Dispositif selon la revendication 1 qui comprend en outre;
- des moyens (28) pour calculer des valeurs numériques moyennes et la valeur numérique d'une erreur standard basées sur les données numériques triées; des moyens pour calculer un index représentatif d'une caractéristique du système cardio-vasculaire du sujet basé sur les valeurs numériques moyennes; dans lequel les moyens de sorties fournissent une grandeur de sortie fonction de l'index.
3. Dispositif pour la mesure fonctionnelle quantitative non invasive de l'élasticité du tissu cardiaque du système cardio-vasculaire. d'un sujet humain comprenant:
- des moyens (12) non invasifs de transducteur d'impulsions fournissant des impulsions représentatives des battements cardiaques détectés sur le sujet humain pendant une pluralité de cycles respiratoires pendant lesquels se produisent de multiples battements cardiaques; et des moyens (14) de synchronisation cardio-respiratoires volontaire sensible aux impulsions fournissant des stimuli qui permettent au sujet humain de synchroniser volontairement ses propres cycles respiratoires avec ses battements cardiaques de telle façon que chaque cycle respiratoire ait une période correspondant à un nombre N prédéterminé de battements cardiaques; et caractérisé par
- des moyens (28) de mesure de la fréquence instantanée des battements cardiaques fournissant des données numériques représentatives de la fréquence instantanée des battements cardiaques à chaque battement cardiaque détecté basées sur les impulsions;
- des moyens (32) de stockage des données numériques pour chaque battement cardiaque détecté;
- des moyens (28) de tri des données pour trier les données numériques stockées selon le battement cardiaque correspondant dans le cycle respiratoire synchronisé volontairement à N battements pendant lequel il s'est produit;
- des moyens (28) d'analyse statistique pour dériver une pluralité de valeurs statistiques numériques basées sur les données numériques triées;
- des moyens (28) d'analyse rythmométrique pour dériver une pluralité de valeurs de paramètres rythmiques numériques basées sur les données numériques triées dans lesquels les moyens (28) d'analyse rythmométrique dérivant une cosinoïde qui s'accorde au mieux aux données numériques et calculent les valeurs des paramètres rythmiques à partir de la cosinoïde dérivée, et dans lesquels les valeurs des paramètres rythmiques comprennent une valeur d'amplitude qui est fonction de la différence maximum-minimum de la cosinoïde dérivée, une valeur de la fréquence instantanée des battements cardisques et une valeur de synchronisation; et des moyens (28, 22, 24) pour fournir un signal de sortie basé sur au moins une des valeurs numériques dérivée des données numériques, lequel signal de sortie est une indication quantitative de l'élasticité du tissu cardiaque du système cardio-vasculaire du sujet.
EP83307347A 1982-12-15 1983-12-02 Appareil médical de mesure non invasive de caractéristiques cardio-vasculaires Expired EP0113200B1 (fr)

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US06/450,066 US4519395A (en) 1982-12-15 1982-12-15 Medical instrument for noninvasive measurement of cardiovascular characteristics

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EP0113200A1 (fr) 1984-07-11
US4519395A (en) 1985-05-28
JPH0512931B2 (fr) 1993-02-19
JPS59120131A (ja) 1984-07-11
DE3378561D1 (en) 1989-01-05

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